Hey everyone. This is an updated version of an article I wrote for AutismAfter16 about 6 years ago! I felt it was worth sharing here, so I’ve gone through and tweaked it to my current standards. This is a topic I care about deeply on a very personal level, and it’s so rarely discussed. Let me know your thoughts!

Autistic people, particularly girls on the spectrum, may be more likely to develop eating disorders and body dysmorphia than their neurotypical counterparts. While research* into this phenomenon is growing, the intersection of these issues isn’t often discussed in the autism world, let alone in contemporary culture.  Do parents of autistic teens know the risks? Do autistics themselves? And where is the connection?

Though the correlation between ASD and eating disorders may seem coincidental, it’s not necessarily surprising to those familiar with both topics. Eating disorders are characterized by obsessive-compulsive behaviors surrounding food and the body, often accompanied by body dysmorphic disorder, or BDD. A large number of girls who go undiagnosed with ASD in childhood receive their diagnoses after seeking help for an eating disorder, and some 20% of patients diagnosed with anorexia nervosa are found to be (unknowingly) on the spectrum.

Tony Attwood, who specializes in girls on the spectrum, has said that because of the ritualized behavior that leads to disordered eating and eventually a diagnosable eating disorder, girls with ASD can obviously be very prone to sliding down that slippery slope. An eating disorder is an obsession that manifests very similarly to a classically autistic “special interest,” and the lure of nutrition, calorie counting, and the seductively vast world of dieting can be fascinating to an autistic, who may only develop the fixated dysmorphia of an eating disorder as a result of his or her newfound obsession. Add some Aspergian food allergies and sensory issues (making eating complicated to begin with) and Aspergian perfectionism into the mix and you’ve got a patient who fits the typical profile of one at risk for an ED.

Not only are people on the spectrum more detail-oriented, perfectionist, obsessive-compulsive, and obsession-prone than neurotypicals, but the very way that autistic people see the world may put them at risk for body dysmorphia. It’s commonly understood that autistic people have problems with abstraction (“big picture thinking”), and, especially when dealing with people, see things as parts instead of a whole. Body dysmorphic disorder is marked by a patient seeing their individual body parts instead of their body as a complete whole. Where a non-BDD patient would look in the mirror and see a face, a patient with BDD sees an eye, another eye, a nose, a mouth, cheeks, etc. This is the same way an autistic personal naturally visually processes a face. The failure to put the pieces together leads to (or can be a result of) focusing on these individual pieces, instead of seeing how they fit together into a greater context.

Ever met someone with a large nose, who hates their nose, while you think it suits them? That’s because you are likely processing their entire face as a whole, whereas they are focusing on their nose as a piece, rather than part of that big picture whole. This phenomenon is the essence of BDD, and the fact that people on the autism spectrum in a sense come equipped with a dysmorphic view of the world can leave them incredibly prone to body dysmorphia and the self-loathing that comes with it, especially for girls, who are immersed from infancy in a society where their physical appearance is the most important aspect of their identity and worth.

Boys on the spectrum may not be subjected to the same social pressures put on girls, but that doesn’t mean they are exempt from eating disorders, or body dysmorphia. Misogynistic cultural pressure may fuel the fire, or be the catalyst, for an autistic girl, but boys are not exempt from physical self esteem issues, and sometimes simply taking an interest in dieting is enough to suck an autistic boy into the same situation. I’ve known several men on the spectrum with obvious (to me) body dysmorphia, and the way they describe their perspective sounds identical to the typical presentation.

Now, I’m not saying that autistic people can’t try to lose weight in a healthy way, or can’t learn about nutritional science, or become nutritionists, or health experts. My sharing this information has less to do with keeping autistics away from these triggers, and more to do with a hope of educating autistic children from an early age about their bodies. Many autistics, and many children in general, don’t give much thought to their bodies until puberty hits.

If you are a parent of a young child, know that the solution isn’t to reassure your daughter that she’s beautiful (in fact, praising little girls for their beauty can be incredibly unhealthy for a myriad of reasons) but to teach her about all her body does. Teach her (or him) about how and why people look different, and about the natural variations in the human form, whether it be fat or thin, big nosed or small. Of course, we’re fighting an uphill battle against our culture here, but a child’s first opinion of his or her body shouldn’t be that they don’t like it.

And if you are an autistic teen (or preteen, or adult) fixating on your body, and your individual parts, know that this is both normal, and not something you need to live with. There is nothing wrong with you. The growth of the body positivity movement has its dark side, but the need for such acceptance is real: We are more than our bodies, and beauty isn’t rent we must pay to exist.  Know that you are not your appearance, and your appearance is more than your individual features.

*A few scholarly articles on the topic:

1. Is anorexia nervosa a version of autism spectrum disorders?
2. Using the Autism-Spectrum Quotient to Measure Autistic Traits in Anorexia Nervosa: A Systematic Review and Meta-Analysis
3. Do girls with anorexia nervosa have elevated autistic traits?